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Home My WebLink About0118 INWOOD LANE S'. . .. V If e .. � .. .. _ Y� D. � .� to _ � � _ " & O ,. � u ,. e 4 �® u j e ' t 0 Town of Barnstable *Permit# Expires 6 months from issue date X-PRESS PERMIT Regulatory Services Fee 4/7, f �s Thomas F.Geiler,Director JUN 21 2006 Building Division N OF BARNSTABLE. Tom Perry,CBO, Building Commissioner TOW 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number t?y"5 Cep 2> Property Address 118 oL. L-/t►�1 55IResidential Value of Work 'k, 5 6®cam Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address L LUM'z-o -P o I&x 3 5-? Contractor's Name&&_fz7r 11L�17 "/KJ(,15'►7 TiLk )e) ,S Telephone Number CSO J)'CZ� -boo Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 0 f V 8 59. .,Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name �t,(r2.!tH �MeIZ4 C li-;J Workman's Comp.Policy# 1 7/(o6 (e-7 e Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ( Re-roof(stripping old shingles) All construction debris will be taken to `"Eu 5 1� � ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side F ❑ Replacement Windows. U-Value (maximum.44) *Where required: lssuan of is permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: ro Own si P perty Owner Letter of Permission. me ro me C tra ors required. SIGNATURE: Q:Forms:expmtrg Revise071405 �'�,��✓✓ 1 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street s4 Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv i7 Name (Business/Organization/Individual): 20pic-Tzi T— Address: I.8q. SCE-1ML ST. City/State/Zip: 'jUi-f QZ"c, Phone #: iZ$-0001 Are you an employer?Check the-appropriate box: -rOTDD D7- Type of project(required): 1.ElI am a employer with 4. (A I am a general contractor aid I 6 1 New construction employees(full and/or part-time).* have hired the sub-contractors ' 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in an capacity. workers'comp. insurance. Y P tY• 9. M Building addition [No workers' comp. insurance 5. 0.We,area corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised*their 3.El am a homeowner doing all work right of exemption per MGL 1 I.[)Plumbing repairs or additions myself. [No workers' comp. C. 152, §1(4),and we have no 12&Roof repairs RcaRoOF insurance required.] t a employees.[No workers' camp. insurance required.] 13.E Other `Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy information: Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy inforrrration. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site reformation. nsurance Company Name: _Z�RIC�4 — VAGi hi f CAtJ 'olicy#or Self-ins.Lic. #: 1 611 Expiration Date: ob Site Address: 1/9ltiuiD ktJ r1 T/ .W_)S T. NA City/State/Zip: 0?_4-7 Z Mach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ; 'ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 4 ine up to$1,500.00 and/or one-year imprisonment, as well aspvil penalties in the form of a STOP WORK ORDER and a fine f up to $250.00 a day against the violator. Be advised that i-cgpy of this statement may be forwarded to the Office of ivestigations of the DIA surance coverage verification. do hereby certify and t e p ins tin en es�er' that the information provided above is true and correct i ature: Date: ZU lo G hone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: t 1L1611 Lf'ari flat Ll ULQ 0/ _L Z) uub d: L4 YAUC, UU4/Ui4 tax Server >, DATE(MM\DD\YY) a1:Uiale CERTIF;IGATE Of INSURANCE — — PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MYCOCK INS AGCY HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 20 SCHOOL ST ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. PO BOX 437 COMPANIES AFFORDING COVERAGE COTUIT MA 02635 COMPANY 2 7 B A AMERICAN ZURICH INSURANCE COMPANY INSURED COMPANY PADGETT BUILDERS INC B PO BOX 133 COMPANY COTUIT MA 02635 C COMPANY D .COVERAGES""... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM\DD\YY) DATE(MM\DD\YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE"OCCUR. PERSONAL&ADV.INJURY $ OWNER'S 8 CONTRACTOR'S PROT" EACH OCCURRENCE $ FIRE DAMAGE(Any one tire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABWTY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per Accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND STATUTORY LIMITS N/A EMPLOYER'S LIABILITY (UB-9716A67-7-06) 06-01-06 06-01-07 EACH ACCIDENT $ Inn n nn THE PROPRIETOR/ INCL DISEASE—POLICY LIMIT $ PARTNERS/EXECUTIVE 50 "r OFFICERS ARE- EXCL DISEASE—EACH EMPLOYEE $ 1 1fl) OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLD CINCELt.ATION ..... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL TOWN OF BARNSTABLE 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE BUILDING INSPECTOR LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR 367 MAIN STREET LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. HYANNIS MA 02635 AUTHORIZED REPRESENTATIVE ACORD.25 S(3(93) ACO;RD CO. ,;C [ATtDN i993,: of gig_ ................ .................. .... . . .................I.......... ............... ........... ....................... ................... ............ ...... ........I...... ...... ............ TE(MI4\DD\YY)................. DA ....................................................... ........... ..................... . .... ....... A.-.T.. .E. INSIUR: AN El : TIF ................................ ER 1� .............................................. ... ......... .............. .......... X.,........... ............. ............. ....................X: ....... THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INSURANCE AGCY CAPE COD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Box 960 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE EAST SANDWICH MA 02537 COMPANY 29BJH A THE TRAVELERS INDEMNITY COMPANY INSURED COMPANY DEBERRY, TODD A. B 228 WOOD ST. COMPANY MIDDLEBORO MA 0234G. C COMPANY D ............ ............. ............................: ` '***' * : .:........................... .......... ................................. ......................................... ........... ........................................... ............I.......I........I...... .......... ................... ......... ................ ..... ................................................................. ....................... ...................................... ......... ...................... .... . ...... ...* ... ' ................. . . . . .... .............*................... ..... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES, DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE(MM\DD\YY) DATE(MM\DD\YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ PERSONAL&ADV.INJURY $ OCCUR.CLAIMS MADEE OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per Accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ .............................. ........... . ............. ... .......... OTHER THAN AUTO ONLY: ......... ....... ................. ............. ... ANY AUTO .................. EACH ACCIDENT $ p AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM ............................ ...... ........... .............. .............. ... ............ WORKER'S COMPENSATION AND .............. STATUTORY LIMITS .............. ...... ............ ... A EMPLOYER'S LIABILITY (UB-038IB09-0-06) 01-1.2-06 01-12-07 ............. ......I..... THE PROPRIETOR/ EACH ACCIDENT $ 1 nn-nno PARTNERS/EXECUTIVE INCL DISEASE-POLICY LIMIT $ nnr) OFFICERS ARE: X EXCL DISEASE-EACH EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. ..-Z.....E...R....T......I..F......I..C.......A.....T......E........H......O........L....D.......E.....R............. ....................................................................... ................................................................... ...... . ........................................... .. ...*.... * .......................*.*... ..........................................................x.......x......:w........ .. . ...... ... ........... .................. ........... ............. .... . C mlA 10 .. ........................ .............................. ......................... .. .............................. .. . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE PADGETT BUILDERS LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR PO BOX 133 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. COTUIT MA 021335 AUTHORIZED REPRESENTATIVE ..................................... .............................. ................. ........ ......... ... ... .......... . .................. .......... ........ .............................. ................... ......... ......... . .............I......... . ....... .................. ................................................ '99 _. .............. ............. .......................... .......... .. ........ ................... ........................................ ....................... RM, 0".: 0 .a ......................I....... .............................................. I................................** "***"*"*' ''*'********....: ......... ...... ......... ............ .............................................................................. a. 00-35 OLIO cf enclosed space . ' � ` . 7°°m��zoruuea o�. aaaac/%uvel�a (MGL C.112 S 601- # P BOARD OF BUILDING REGULATIONS ry. Y. ` 1 A-Mason only License CONSTRUCTION SUPERVISOR r 1G-1&2 Family Homes Failure to possess a current edition of the NumbeCS O48859s Massachusetts State Building Code k vocation of this Ilcense.';�62221944 ais cause forre s pire .p 2 008 Tr.no: ;.17133. t S. ROBERT R PADC�Es �• 1.84 SCHOOL ST%R` B Z• i\ 63 COTUIT,'MA 02635" '" + DIG SAFE CALL CENTER: (888)344-7233 Gommiosioner Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrationl.� 0131 Board of Building Regulations and Standards ��ExpIratron_6/9/2008 One Ashburton Place Rm 1301 t - d+5 Boston,M . 2 08 JType=Pnvate Corporation PADGETT BUILDERS1INC' 0 Robert Padgett PO Box 133/184 School-Str.' Cotuit,MA 02635 Deputy Administrator Not valid without signatu �r Assessor's offioe (1st floor): / ' SEPTIC SYSTEM MUST �t Assessor's map and lot number ...Z�}5.......... ....... KASTALLED 1N COMP Boarei of Health ,(3rd floor): I / c WITH�oYd.E fO� Sewage Permit number .................................................... ...... ppi�s, M NT ,..:. , S ENVIRONMENTAL E AL C 9TI�DLE Engineering Department (3rd floor): YJ1B& ber TOWN REGULATI t6}9- House num �0 ......................................././..1�.......................... "�o raY a APPLICATIONS PROCESSED 8:30 9:30 A.M. and 1:00-2:00 P.M. only. TOWN 'OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ! ! TYPE OF CONSTRUCTION ..........I�IG.f? .....I�Y1H!U/.. -.................................................................................. ..,7x...--.�.............19 T.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....:r�. (�l< ........ ........L!i1.../..7.��!/�'�!?� .............. .................................................................................. ProposedUse ... hx.....................................................................................................................................:..................... ZoningDistrict /. .. ..........................................Fire District ........................................................................ ..... Name of Owner ..Pi..l�N�.� C:!!..1.��C�.z.d......................Address � .....11l Name of Builder ..... ........�......... .................Address 21 ..../ro. ..!,d�%1../.�1'/.G:�..�:�: �......... ..... . Name of Architect ...L.1 /!y`....... .................Address ...... 11f!ll Numberof Rooms ..................................................................Foundation ....L.lJ/!Ir!V....... .............................................. Exterior ...t,4 .CV.tl....54!e;rI. ✓.`.......................................Roofing .......Ar, .. ...,4`FloorsdH�? . .. .. ...................................................Interior ........ . G. .................................................................. LPG ►�f/l / Heating ..... l—' g Fireplace ......�.................:....................................................Approximate Cost ......0.. Definitive Plan Approved by Planning Board ____________________19-------- . Area ......... ...5:."�y Diagram of Lot and Building with Dimensions Fee ll SUBJECT TO APP -24 to .ZZ V Y OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Ba table regar 'ng the above construction. Name ... ........ . ... ......... . . ....................................... Construction Supervisor's License .................................... i RYMZO, DR. WALTER 39438 ADD GARAGE No .. ............. Permit for .................................... Single Family Dwelling ,;..........� ..... .............. Location ............ et ................. .................... .............. Owner ......D ......Walter..Rym 0................. Type of Construction ....:.Frame,,,,,,,,,,,,,,,,,,,,,, �! f ................................................................:.............. f w+ Plot . Lot .:................ r• ,. r, �^ February 18', 8 7 Permit Granted ............I............... ........19 Date of Inspection ...................................'19 Date Completed ............................:......19 z r r t t/ 7 Z/ .? "Y ,9 i, .( 'wa � s � - •,,,.+R' 7, t� r• tit - rj r r ,- •1E3r.. � w, � • r Assessor's offioe (1st floor): /�� oFTHETO Assessor's map and lot .number ...! 4 r .... Boardtof Health (3rd floor): N.� , �f Sewage Permit number i BaB39TSDLE, ! Engineering Department (3rd floor): o Y 39 e� House number )1 o,s�t6}q• \ ........................................�l. ........................ 'Ea NO a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only s TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .................................... TYPE OF CONSTRUCTION .IVAP J—TiAW �.. ..............• t/7, /G......... r.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to/the following information: 4 Location .....................-,i............................ ......... ........1�`.�./?.......................................................................................................... /��q ,� Proposed Use ....._�.........�.......................................................................................................................................................... ZoningDistrict .................. /..........................................Fire District ........ ............................... .................. ►// �1�I��iY G f l�(GN Z C> �l�vll�t J t �(/...../,.,/, `//'�G1l�i�DIl Name of Owner .................................. ....................................Address ................�................ ............................. 41 Name of Builder .................. Address Name of Architect .... ./Aw,/.... T i.! ' ......................Address ......`./...:!.17? .....�;•!./�/`� ........................................ Number of Rooms .... ...... ...................................................... ......<...r....`. ` Exterior .... lv .....,/!'I!//f./. �1.....................................Roofing /!.:,' Alr . .... ................_............................................ Floors rOO6.... .?°.� .. .Interior ........5...., /A........ ............................................... \oc Heating ................?............:...................................Plumbing ..........f.........0.:............................ ............................. Firepp ................................Approximate Cost 4,G�O�J lace ..................... .......�.,......................... Definitive Plan Approved by Planning Board ________________________________19________ . Area ...-a .......... ...S O�C� -Diagram of Lot and Building with Dimensions Fee .................. L SUBJECT TO APPROVAL Of BOARD-0E— EALTH 2Z OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barn table regarding the above construction. /i Name ..�. ....... .�.. ...................................... Construction Supervisor's License .................................... DYM%O, DR. VVAI,TEIl "/A=245-008 � - - --- --- No ..4. 4-38-� Permit for - &D-D �A- GI - . ) ' . ' S -iu l Family l Dwelling °�---' ' - Location -. ----. . ,- , t ------------. ----- ^ Owner .........D��-�VV�lt.��_Bvnuz��_____ Type of Construction -' -------' --------------------------. Plot ...................... Lot ----------' ' Permit G,onne6 -'I7e�Kp..-jKy.-�8��_lp 87 Date of Inspection ------------lP Dote Completed ------------'lP w . OZx�m�aj ' / ' . ` / ` ^ _